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169 Cards in this Set

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Blood volume:

Males?

Females?
Males: 5-6 liters

Females: 4-5 liters
Hematocrit?

Males %?
Females %?
-The percentage of the blood volume that consists of red blood cells

-Males: 42–52%
-Females: 37–47%
Majority of plasma is made of?

Aslo contains?
-90% water

-Contains ions (Na+), nutrients, hormones, enzymes, antibodies, wastes, and proteins
Three plasma proteins?
Albumin

Globulins

Fibrinogen
produced by the liver and provide the osmotic pressure needed to draw water from the surrounding tissue fluid into the capillaries
Albumin (60-80%)
Different types of globulins? Where produced? Function?
alpha, beta, gamma. Alpha, beta are produced by the liver and function in transporting lipids and fat-soluble vitamins and function in immunity
Specific use of gamma globulins?
Can be used in viral infections

Example: Hep-A increases pt immunity
________, is an important clotting factor produced by the liver.
The fluid from clotted blood, called ________
-Fibrinogen

-serum
Formed elements?
Blood cells:
Erythrocytes
Leukocytes
Platelets
each hg molecule consists of four protein chain called ______, each of which is bound to one ______, a red-pigmented molecule that contains iron, the iron group is able to combine with oxygen in the lungs and release oxygen in the tissues
-globins

-heme
_________ produces RBCs during intrauterine life. After birth they are produced in the ________ stimulated by the hormone ________
-wall of the yolk sac

-red bone marrow

-erythropoietin
where is erythropoietin
90% in kidney the rest in the liver
Function of basophil?
releases histamine and other inflammatory mediators
Function of Eosinophils
allergy and parasitic infection
The largest leukocytes,
Are phagocytic cells
Nucleus: kidney shaped
Transform into macrophages
Monocytes
___________ release _______ which stimulates constriction of the blood vessels, reducing the flow of blood to the injured area
platelets release serotonin
platelets also secrete
Platelets also secrete growth factors , autocrine regulators.
Erythropoiesis
myeloid and lymphoid
Myeloid tissue is ?
the red bone marrow of the long bones, sternum, pelvis, bodies of the vertebrae.
Lymphoid tissue includes ?
the lymph nodes, tonsils, spleen, and thymus.
All blood cells originate in
red bone marrow
Pernicious anemia
inadequate amount of vitamin B12
Aplastic anemia
due to destruction of the bone marrow may be caused by chemical or by radiation.
Granulocytes form from _________
myeloblasts
Monoblasts enlarge and form _______
monocytes
Platelet-forming cells from _______ which break apart into platelets
megakaryoblasts
Polyvera? aka?
aka polycythemia – excess RBCs due to abnormality of bone marrow
signs and symptoms of polyvera?
Increased RBC, WBC, platelts  pt has spleomegaly (enlarged spleen), hepatomegaly (enlarged liver), vertigo, headache, increased BP (htn), increased hematocrit
Anemia?
erythrocyte levels or hemoglobin concentrations are low
Normocytic anemia
such as blood loss
Microcytic anemia
RBC are small as in iron deficiency
Macrocytic anemia
erythrocytes are bigger than normal in Vit B12 or Folate deficiency
Thrombocytopenia
Abnormally low concentration of platelets
Normal red blood cells contain _________.

Abnormal blood cells contain______ and ______
-hemoglobin A

-Hemoglobin S and hemoglobin C
Spleen collects dead RBC and converts them into
bilirubin
What is jaundice?
increase in biliruben
Treatment of sickle cell?
Patients should take folic acid and Antibiotics and vaccines are given to prevent bacterial infections.
Lymphocytic (or lymphoblastic) leukemia
affects white blood cells called lymphocytes, it produces large numbers of mature white blood cells (lymphocytes).
Myelogenous leukemia
affects white blood cells called myelocytes. It produces large numbers of immature and mature white blood cells (myelocytes).
Treatment of leukemia?
chemotherapy, Interferons, Radiation, stem cell transplant
Interferon used in leukemia? function
Interferon-alpha (INFa) therapy to slow the reproduction of leukemia cells and promote the immune system's anti-leukemia activity
Tunica intima?
composed of simple squamous epithelium
Tunica media?
sheets of smooth muscle
Tunica externa?
composed of connective tissue
______ is the thickest tunic in veins
Tunica externa
Wide, leaky capillaries found in
spleen, liver…
Sinusoids
Is elasticity higher in arteries or veins?
arteries
The blood volume contained in the arteries is called the _______

The volume in the veins is called the ________
-stressed volume.

-unstressed volume.
-are the site of highest resistance in the cardiovascular system.
-have a smooth muscle wall that is extensively innervated by autonomic nerve fibers
arterioles
Alpha1-Adrenergic receptors are found on
the arterioles of the skin, splanchnic, and renal circulations.
-Beta2-Adrenergic receptors are found on
arterioles of skeletal muscle.
capillaries consist of a single layer of endothelial cells surrounded by ______
basal lamina
contain the highest proportion of the blood in the cardiovascular system
veins
Veins have _______-adrenergic receptors.
alpha 1
blood flow velocity is _______ in the aorta than in the sum of all of the capillaries
higher
The greater the amount of elastic tissue in a blood vessel, the higher the elastance, and the ______ the compliance
lower
The largest decrease in pressure occurs across the _________ because they are the site of highest resistance.
arterioles
Aorta mean pressure?
100 mm Hg
Arterioles mean pressure?
50 mm Hg
Capillaries mean pressure?
20 mm Hg
Vena cava mean pressure?
4 mm Hg
the difference between the systolic and diastolic pressures
pulse pressure
The most important determinant of pulse pressure is
stroke volume
Decreases in capacitance, such those that occur with the aging process, cause __________ in pulse pressure.
increases
primary htn? aka?
aka essential htn

htn of unknown etiology
Cushing's syndrome
a condition caused by an overproduction of cortisol (overproduction of all 3 cortext hormones: cortisol, aldosterone, andogrens)
Hyperaldosteronism? aka?
aka konns disease too much aldosterone
Pheochromocytoma
a rare tumor that causes over secretion of hormones like adrenaline and NA
Preeclampsia
a condition related to pregnancy, endothelial dysfunction in the maternal blood vessels
parathyroidism
Hyperparathyroidism = hypercalcemia; excess calcium causes over stimulation of smooth muscle = HTN
reason for headache symptom in secondary htn?
Meningeal layer is innervated by sensory branch of trigeminal nerve CN5
Angiotensin-converting enzyme (ACE) inhibitors
Captopril, Ramipril
Angiotensin || receptor blockers (ARBs)
Valsartan
Calcium channel blockers
Felodipine, Benidipine
P-wave length
usually 0.08 to 0.1 seconds (80-100 ms) in duration.
the P-R interval length
normally ranges from 0.12 to 0.20 seconds in duration
QRS complex length
normally 0.06 to 0.1 seconds
QT Interval length
can range from 0.2 to 0.4 seconds depending upon heart rate
depolarization/upstroke of SA and AV node is caused by
inward current of calcium
depolarization of ventricles, atria and Purkinje fibers
result of an inward Na+ current.
slow depolarization of SA node to threshold is by? This is called?
inward current of Na

If (slow depolarization, produced by the opening of Na+ channels and an inward Na+ current called If). (“f” which stands for funny).
conduction velocity is fastest in ______ and slowest in _______
-purkinjie fibers

-AV node
chronotropic
rate
dromotropic
conduction velocity
inotropic
force of contraction
Reentry typically occurs when ?
when slow-conducting tissue (eg, infarcted myocardium) is present adjacent to normal tissue.
magnesium deficiency is associated with? so is deficiency of what other ion?
PVC's

Potassium
hypercapnia and hypercalcemia are associated with?
PVC
Class 1 agents? Examples?
Sodium channel blockers

lidocaine, Phenytoin
Class 2 agents? Examples
Beta-1 blockers; decrease conduction through the AV node.

Class II agents include atenolol, propranolol, and metoprolol.
Class 3 agents? Effect on conduction velocity? Example?
Block the potassium channels, thereby prolonging repolarization.

Since these agents do not affect the sodium channel, conduction velocity is not decreased.

Sotalol
Class 4 agents? Examples?
Calcium channel blockers.

Class IV agents include verapamil and diltiazem.
class 4 agents mechanism?
They decrease conduction through the AV node, and shorten phase two (the plateau) of the cardiac action potential. They thus reduce the contractility of the heart, so may be inappropriate in heart failure. However, in contrast to beta blockers, they allow the body to retain adrenergic control of heart rate and contractility
Contractile cells are extremely efficient at extracting oxygen; they extract _______ of the oxygen from the passing blood—about twice the amount of other cells
roughly 80%
intrinsic ability of the cardiac muscle to develop force at a given muscle length.
contractility/inotropism
ejection fraction? normal value?
(stroke volume/end-diastolic volume)

normally 0.55 (55%).
cardiac glycoside example? effect on heart
positive inotropic effect

digitalis
Increased preload causes an increase in _______ based on the Frank-Starling relationship.

Effect on the pressure volume loop graph?
-stroke volume

-The increase in stroke volume is reflected in increased width of the pressure-volume loop.
Increased afterload refers to an increase in aortic pressure resulting in a decrease in _________.

Effect of pressure-volume loop?
-stroke volume

-The decrease in stroke volume is reflected in decreased width of the pressure-volume loop.
-The decrease in stroke volume results in a ________ in end-systolic volume.
increase
The increase in stroke volume results in a _______ in end-systolic volume
decrease
Stroke volume equation
EDV - ESV
Cardiac output equation
CO = SV X HR
Ejection fraction definition and normal value?
-is the fraction of the end-diastolic volume ejected in each stroke volume.
-is related to contractility.
-is normally 0.55, or 55%.
Ejection Fraction equation?
EF = SV/EDV
When the pressure in the left ventricle rises above _________(which is the pressure in the aorta), the aortic valve opens
80 mmHg
The period during which the ventricles empty blood into the aorta is known as the ________
ejection period.
The first heart sound is produced (indirectly) by the closure of the AV valves; it is of _____ pitch and of relatively _____ duration.
-low

-long
The second heart sound is produced (indirectly) by the closing of the aortic and pulmonary semilunar valves; this is of _____ pitch and of relatively ______ duration.
-high

-smaller
Cardiac output (CO) definition?
the amount of blood each ventricle can pump in one minute
Sympathetic nerve distribution on the heart
Sympathetic nerves are distributed to SA and AV nodes with more innervation in the ventricles than the parasympathetic
All stages of atherosclerosis—from initiation and growth to complication of the plaque—are considered __________________________
an inflammatory response to injury
atherosclerosis
nitric oxide
________ in the plaque produce some enzymes which digest the _______
-macrophages

-fibrous cap
Lead I 
is between the right arm and left arm electrodes, the left arm being positive.
Lead II
is between the right arm and left leg electrodes, the left leg being positive.
Lead III
is between the left arm and left leg electrodes, the left leg again being positive.
V1 & V2
Right Ventricle
V3 & V4
Septum/Lateral Left Ventricle
V5 & V6
Anterior/Lateral Left Ventricle
Pain as diagnostic criteria for MI
Clinical history of ischaemic type chest pain lasting for more than 20 minutes.
diagnostic criteria rise and fall of serum cardiac biomarkers such as
creatine kinase -MB fraction and troponin T and I and myoglobin, Lactate
______ are more specific for myocardial injury
dehydrogenase
The _____________which are released within 4–6 hours of an attack of MI and remain elevated for up to 2 weeks
cardiac troponins T and I
The following increase chances for developing _______:
-Artificial heart valves
-Congenital heart disease (atrial septal defect, patent ductus arteriosus)
-Heart valve problems (such as mitral insufficiency).
-History of rheumatic heart disease.
endocarditis
endocarditis symptoms
Abnormal urine color
Chills (common)
Excessive sweating (common) Fatigue
Fever (common)
Joint pain
Muscle aches and pains
Night sweats
Nail abnormalities (splinter hemorrhages under the nails) Paleness
tests for endocarditis?
Erythrocyte sedimentation rate (ESR)

Transesophageal echocardiogram
endocatditis treatment
Long-term, high-dose antibiotic treatment is needed to get rid of the bacteria. Treatment is usually given for 4-6 weeks
mitral stenosis causes
-Rheumatic fever
-Congenital mitral stenosis
mitral stenosis symptoms
atrial fibrillation
severe pulmonary hypertension
right ventricular hypertrophy
hemoptysis
edema
treatment for mitral stenosis
Cardiac Glycosides: These agents alter the electrophysiologic mechanisms responsible for arrhythmia. Digoxin (Lanoxin)
Digoxin
Negatively chronotropic - i.e. slowing the heart rate by decreasing conduction of electrical impulses through the AV node, making it a commonly used antiarrhythmic agent in controlling the heart rate during atrial fibrillation or atrial flutter.
Positively inotropic - i.e. increasing the force of heart contraction via inhibition of the Na+/K+ ATPase pump.
The following are causes of ________:
-Mitral valve prolapse
-Congenital
-Atherosclerosis
-Endocarditis
-Heart tumors
-High blood pressure
-Marfan syndrome
-Untreated syphilis
Mitral regurgitation
% of cardiac output to Cerebral =
Cerebral=15%
% of cardiac output to Coronary =
Coronary=5%
% of cardiac output to Renal =
Renal=25%
% of cardiac output to Gastrointestinal =
Gastrointestinal=25%
% of cardiac output to Skeletal muscle =
Skeletal muscle=25%
% of cardiac output to Skin =
Skin=5%
Regulating of arterial Pressure:

Fast mechanism?
Slow mechanism?
-Fast mechanism: neural, (baroreceptor)

-Slow mechanism: hormonal (renin-angiotensin-aldosterone)
Baroreceptors are stretch receptors located ?
within the walls of the carotid sinus near the bifurcation of the common carotid arteries.
baroreceptors are most sensitive to changes in __________

Additional baroreceptors in the aortic arch respond to ___________, in arterial pressure
-arterial pressure

-respond to increases, but not to decreases
Decreased stretch decreases the firing rate of the carotid sinus nerve cranial nerve ___, which carries information to the vasomotor center in the brain stem.
IX
The set point for mean arterial pressure in the vasomotor center is about ______. Therefore, if mean arterial pressure is less than that, a series of autonomic responses is coordinated by the vasomotor center. These changes will attempt to increase blood pressure toward normal
100 mm Hg
Renin is an enzyme released from the _________. Renin's substrate is from the _______ and is formed into __________
-juxta glomular apparatus

-liver

-Angiotensin 1
Angiotensin 1 is inactive and is activated to ________ by ______ in the ________
-Angiotensin 2

-ACE in the lungs
Angiotensin 2 function? degraded by?
-increases aldosterone concentration and vasoconstriction

-degraded by angiotensinase
chemoreceptors are located ?
are located near the bifurcation of the common carotid arteries and along the aortic arch.
Decreases in Po2 activate ___________ that produce vasoconstriction, an increase in TPR, and an increase in arterial pressure.
vasomotor centers in the medulla
Atrial Natriuretic peptide
-Receptor-agonist binding
-Inhibits renin secretion, thereby inhibiting the renin-angiotensin system.
-Reduces aldosterone secretion by the adrenal cortex.
-Relaxes vascular smooth muscle in arterioles and venules
In the liver and intestine, the clefts are
exceptionally wide and allow passage of protein. These capillaries are called sinusoids
In the brain, the clefts between endothelial cells are
are exceptionally tight (blood-brain barrier).
Large water-soluble substances can cross capillaries by
pinocytosis
HTN treatment when angiotensin 1 is in excess?
ACE inhibitor: catopril
HTN treatment when angiotensin 2 is in excess?
Angiotensin 2 inhibitor?=: valsartan
HTN treatment for polycystic kidney disease?
HCTZ diruetic
HTN treatment for hypercalcemia?
calcium channel blocker: benidipine
HTN treatment for overactive sympathetic
propanolol
capacitance (compliance) is directly proportional to ______ and inversely proportional to _______
-volume

-pressure

C = V/P
capacitance (compliance) describes ?
how volume changes in response to a change in pressure
In coarctation of the aorta, a birth defect in which the aorta is narrowed,
BP is too high in arch/CNS and too low in femoral artery
Hyperparathyroidism role in secondary htn?
increases the calcium reabsorbtion by epithelial cell of small inestine
Increases renal reabsorbtion
Removes extra calcium from bone and releases into blood stream
Hyperparathyroidism = hypercalcemia; excess calcium causes over stimulation of smooth muscle = HTN
Atria, ventricle, purkine systems resting membrane potential?
-90mV
Order of ion events in atrial and vetrical muscles?
Phase 0 - Influx of sodium
Phase 1 - Outward flow of potassium
Phase 2 - inward flow of calcium
Phase 3 - outward flow of potassium/calcium stops
Phase 4 - resting potential reached
Order of ion events in SA node?
Phase 0 - calcium flows in
Phase 3 - repolarization - calcium/potassium flows out
Phase 4 - slow depolarization - inward flow of sodium
Phase 4 of nodal cell is called?

Phase 1 and 2 of nodal cell?
-iF = funny current

-Phase 1 and 2 of nodal cell are not present
The left ventricle is filled with blood from the left atrium and its volume is about ______ = end-diastolic volume
140 mL
The volume that is ejected in ventricular systole is the _________. The volume remaining in the left ventricle at point 3 is about _______ = end-systolic volume.
-stroke volume

-70mL
Once left ventricular pressure decreases to less than left atrial pressure, the mitral (AV) valve opens and filling of the ventricle begins. During this phase, ventricular volume increases to about _______ = the end-diastolic volume.
140 ml